Alkylation refers to a chemical substitution that occurs when an alkyl group from the chemotherapy drug is substituted for a hydrogen molecule on the DNA strand. This causes the DNA strand to break apart or to bind together incorrectly. The cell is then unable to divide properly. All alkylating agents are derivatives of nitrogen mustard.

Alpha/Beta Adrenergic Blockers

This drug combines a nonselective beta blocker plus an alpha blocker that decreases the heart rate and cardiac output.

Aminoglycosides

The aminoglycosides comprise a group of antibiotics that kill bacteria by interfering with the synthesis of protein in the bacterial wall, causing disruption of intracellular contents and cell death. Aminoglycosides are primarily effective against gram-negative bacteria.

Anabolic Steroids

Anabolic steroids change the natural balance in the body between anabolism (tissue building) and catabolism (tissue breakdown) These drugs increase tissue building and have been used for years by athletes to increase muscle mass, strength, and endurance. Although the used of these drugs is illegal in professional sports, the practice continues. In AIDS patients, anabolic steroids have been legitimately prescribed to counteract the wasting syndrome.

Analgesic

A drug that selectively suppresses pain without producing sedation.

Anesthetic, general

A drug that eliminates pain and voluntary muscle control by inducing unconsciousness.

Anesthetic, local

A drug that eliminates pain perception in a limited area by local action on sensory nerves.

Antacids

Antacids were the original, and for many years the only, treatment for peptic ulcers. They are weak bases that exert a therapeutic effect by neutralizing acid. By raising the pH, they also inhibit the action of pepsin. They contain aluminum, magnesium, calcium, sodium, or a combination of these as the active ingredients. Antacids are available without a prescription.

Antagonist

An overdose of a narcotic drug can be counteracted by giving a narcotic antagonist intravenously. Narcotic antagonists compete for the same receptor sites as the narcotic and so it decreases its toxic effects, particularly the effect of respiratory depression.

Antibiotic

A drug used to cure infections by killing pathogenic bacteria.

Anticholinergic

A drug that opposes the action of acetylcholine (a neurotransmitter for the parasympathetic nervous system) at the site of cholinergic receptors. Anticholinergic drugs exert a predictable set of side effects called anticholinergic effects. The ABCs of anticholinergic side effects: A - anticholinergic. B - blurred vision, bladder retention. C - constipation. D - dry mouth.

Anticoagulants

Blood coagulates to form a clot following a complex series of steps involving clotting factors I through XIII and platelets. Anticoagulants prevent clot formation; they are ineffective against a clot that has already formed. Anticoagulants and platelet aggregation inhibitors are used to prevent deep venous thrombosis (DVT); to prevent clots from forming postoperatively after heart, valve, or vascular surgery; and to decrease the risk of a stroke in patients who have had transient ischemic attacks.

Antidepressant

A psychotherapeutic drug that produces mood elevation. These drugs are also known as mood-elevating drugs.

Antiemetic

A drug that prevents or relieves vomiting. (Emesis means vomiting.)

Antifungal

A drug used to treat fungal infections.

Yeasts, which are closely related to fungi, grow easily in the warm, dark environment of the mouth, particularly in immunocompromised patients. Candida albicans infections are alternatively known as oral candidiasis, monilia, or thrush. Antifungal drugs are applied topically as a solution (the patient is told to "swish and swallow") or supplied as a troche (to suck on as a lozenge). Nizoral is also available as an oral tablet that acts systemically.

Antihistamine

A drug used to decrease the symptoms of inflammation caused by histamine released during an allergic reaction.

Antihistamines exert their therapeutic effect by blocking histamine (H1) receptors in the nose and throat. Histamine is released by the antibody-antigen complex that occurs during allergic reactions. Histamine causes vasodilation which causes blood vessels and tissues to become engorged, swollen, and red. Histamine also irritates these tissues directly, causing pain and itching. Antihistamines block the action of histamine at the H1 receptors. Antihistamines dry up secretions, shrink edematous mucous membranes, and decrease itching and redness. A significant side effect of early antihistamines was drowsiness; however, newer antihistamines have a different chemical structure that does not cross the blood-brain barrier to produce drowsiness.

Antihistamines are only effective in treating allergic reactions which release histamine. They are not effective in treating the common cold. Although symptoms of allergies and colds are similar, there is no release of histamine with the common cold. Nevertheless, pharmaceutical manufacturers continue to combine antihistamines with decongestants in cold remedies, perhaps because antihistamines have some effect in drying secretions. Antihypertensive

A drug that lowers high blood pressure.

Anti-inflammatory

A drug used to decrease the symptoms of inflammation by inhibiting the release of prostaglandins. This term is always hyphenated. Antimetabolite Chemotherapy Drugs

As a group, antimetabolites compete with substances that are necessary for cell metabolism and DAN synthesis. Acting as antagonists, antimetabolites take the place of necessary chemicals within a cell while also blocking the necessary substance from entering the cell. Cell metabolism is disrupted and the cell dies.

Antineoplastic

A drug that is selectively toxic to rapidly dividing cells such as malignant cells.

Antipruritic

A drug that prevents or relieves itching. (Pruritus means itching.)

Antipsychotic drugs

These drugs are also known as major tranquilizers or neuroleptics.

Antiseptic

A drug that inhibits the growth of bacteria without destroying them. antiseptics are used topically, not internally.

Antispasmodic

A drug used to stop the spasm of voluntary or involuntary muscles.

Antitussive

A drug that suppresses coughing.

Antitussives act to decrease coughing by suppressing the cough center in the brain or anesthetizing the stretch receptors in the respiratory tract. There main purpose is to stop nonproductive dry coughs. They are not prescribed for a productive cough that generates sputum because it is important for the patient to cough up this sputum. Some antitussives are narcotics, such as codeine and hydrocodone; these are prescription schedule drugs. Over-the-counter antitussives contain the nonnarcotic dextromethorphan or diphenhydramine.

Antiviral

A drug used to treat viral infections.

Barbiturates

Barbiturates are sedative drugs; some of them also possess an anticonvulsant action. Barbiturates are Schedule III and IV drugs that act to inhibit conduction of nerve impulses to the cortex of the brain and to depress motor areas of the brain.

Barbiturate Hypnotics

Some barbiturates are useful in preventing epileptic seizures. Others have no anticonvulsant activity and are used to treat insomnia. They produce a general depressing action on the central nervous system and sedation. However, barbiturate hypnotics are Schedule II and II drugs and, because of their greater ability to cause addiction, are not preferred over the nonbarbiturates hypnotics. They also appear to lose their therapeutic effect when used for just a few weeks.

Benzodiazepines

The benzodiazepines are by far the most commonly prescribed drugs for the treatment of anxiety and neurosis. They bind to several specific types of receptor sites in the brain to provide sedation and affect thought processes; they affect emotional behavior by their action in the limbic area of the brain; and in the spinal cord they decrease the muscle tension that comes with anxiety. All of the benzodiazepines are Schedule IV drugs.

Beta Blockers

Although nitrates, particularly nitroglycerin, comprise the standard for antianginal therapy, beta blockers may also be prescribed. Beta blockers act to decrease the heart rate which in turn decrease the need of the myocardium for oxygen; this decreases anginal pain.

For patients who have had a myocardial infarction, the beta blockers propranolol (Inderal) and timolol (Blocadren) are prescribed to reduce the risk of a second heart attack.

Not all beta blockers are indicated for treating angina; beta blockers are also used to treat hypertension and arrhythmias.

Bronchodilators

Bronchodilators are used to treat asthma, COPD, emphysema, and exercise-induced bronchospasm. Bronchodilators relax the smooth muscle that surrounds the bronchi, thereby increasing air flow. This dilatation of the bronchi is due either to stimulation of beta2 receptors in the smooth muscle of the bronchi, to the release of epinephrine which itself stimulates beta2 receptors, or to inhibition of acetylcholine at cholinergic receptor sites in the smooth muscle.

Some bronchodilators are given orally; some are given intravenously; some are prescribed as a solution or a powder in a dispenser (inhaler) which a special mouthpiece. The dispenser automatically injects a premeasured dose into the lungs as the patient inhales through the mouth. The prescribed dosage for these metered-dose inhalers is in number of puffs.

Calcium Channel Blockers

Calcium channel blockers may be used in conjunction with nitrates or beta blockers to treat angina. Calcium channel blockers relax the smooth muscle of the blood vessels to decrease arterial pressure, the pressure the heart must pump against. This decreases the heart's need for oxygen. This same action also dilates the coronary arteries and prevents coronary artery spasm which can trigger angina.

Cardiac glycosides

Class of digitalis drugs used to treat congestive heart failure.

Cephalosporins

The cephalosporins are a group of antibiotics that can call bacteria. They accomplish this by interfering with the structure of the cell wall that surrounds bacterium, causing disruption of the intracellular contents and cell death. This group of antibiotics is further divided into first-, second-, and third-generation cephalosporins. This designation has nothing to do with when these antibiotics were discovered or first marketed, but instead it divides them by their therapeutic antibiotic properties. First-generation cephalosporins are generally inactivated by bacteria that produce penicillinase, while third-generation cephalosporins show the greatest activity against resistant bacteria. In addition, the third-generation cephalosporins show greater activity against gram-negative bacteria in general; however, the cost of these drugs is greater. Cephalosporins and penicillins are structurally similar, and patients who are allergic to penicillin may have an allergic reaction if given cephalosporin antibiotics.

Chemotherapeutic Antibiotic Drugs

Most antibiotics act only on the cell wall of bacteria. Human cells, which do not have a cell wall (they only have a cell membrane), are not affected by standard antibiotics. However, a special class of antibiotics is used as chemotherapy drugs. These drugs do affect human cells. All of the chemotherapeutic antibiotics act on DNA to inhibit synthesis of it or to break or bind DNA strands so that cell division cannot be completed. Chemotherapy antibiotics are never used to treat bacterial infections.

Corticosteroids

Natural corticosteroids, produced in the adrenal cortex, have a powerful anti-inflammatory action. Corticosteroid drugs used to treat the inflammation associated with arthritis, bursitis, and tendonitis are given orally. Some corticosteroids can be injected directly into the joint (intra- articular administration). Because of the side effects associated with prolonged oral use, corticosteroids are only used to treat acute exacerbations.

Corticosteroids (hydrocortisone and cortisone) are produced naturally by the adrenal glands. They suppress the inflammatory response of the immune system. Manufactured corticosteroids reduce inflammation and tissue edema associated with chronic lung disease. They do not produce bronchodilation; therefore, they are always used in conjunction with bronchodilators. They are administered prophylactically, because they are not effective during the acute attacks of bronchospasm. These drugs are given by inhaler, and the dosage is prescribed in numbers of puffs.

Decongestants

Decongestants act as vasoconstrictors to reduce blood flow to edematous tissues in the nose, sinuses, and pharynx; they achieve this vasoconstriction by stimulating alpha receptors in these tissues. Decongestants decrease the swelling of mucous membranes, alleviate nasal stuffiness, allow secretions to drain, and help to unclog the eustachian tubes. Decongestants are commonly prescribed for colds and allergies. They can be administered topically as nose drops or nasal sprays, or can be taken orally. Decongestants are often combined with antihistamines in cold remedies.

Digitalis

refers collectively to all of the cardiac glycosides.

Diuretic

A drug used to treat edema and hypertension by causing the kidneys to excrete more sodium and water.

The kidneys filter circulating blood, extracting waste products, water, sodium, potassium, and various other substances. They also regulate the blood volume by retaining or excreting sodium ions which in turn cause water to be retain or excreted. Diuretics keep excreted sodium from being reabsorbed from the tubule back into the bloodstream. As the sodium is excreted in the urine, it brings water from the tubule with it because of osmotic pressure. By causing extra sodium and water to be excreted from the circulating blood volume, diuretics are useful in the treatment of hypertension.

Diuretics are divided into several groups on the basis of the site of their actions within in the kidney: thiazide diuretics, loop diuretics, and potassium-sparing diuretics.

Emetics

Drugs that induce vomiting are useful only if the patient is conscious and will not aspirate. This treatment is not helpful if the drug has already been absorbed from the stomach into the bloodstream.

Expectorant

A drug that thins mucus in the respiratory tract to make it easier to cough up.

Expectorants act to reduce the viscosity or thickness of sputum so that patients can more easily cough it up. Expectorants are prescribed only for productive coughs.

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General Anesthetic Drugs

General anesthesia involves the loss of consciousness to produce anesthesia, a technique which distinguishes it from all other types of anesthesia. In the operating room, the patient is first given a drug to induce general anesthesia. Once the patient is unconscious and intubated, then other anesthetic agents are given to maintain general anesthesia. Drugs for induction of anesthesia are generally given intravenously; drugs used to maintain general anesthesia may be given intravenously or by inhalation.

Gold Salts

Gold salts contain actual gold (from 29% to 50% of the total drug) in capsules or in solution for injection. Gold salts are used to treat active rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease in which the patient's own macrophages attack and damage cartilage. Gold salts inhibit the activity of macrophages but cannot reverse past damage. Unlike antiarthritis drugs, gold salts are never prescribed for osteoarthritis as this disease is caused by degenerative wear and tear, not by an immune response. NSAIDs are the first line of treatment for rheumatoid arthritis, but if these fail, gold salts may be added to the treatment regimen.

H2 Blockers

The release of gastric acid is triggered by histamine which acts on special histamine receptors (known as H2 receptors) in the gastric parietal cells lining the stomach. Drugs that block these receptors and prevent the release of acid are known as H2 blockers and are used to treat ulcers and gastroesophageal reflux disease (GERD).

Hormonal Chemotherapy Drugs

Certain tumors, specifically those arising from the tissue influenced by the hormones estrogen and progesterone/androgen, show regression when treated with a drug that produces the opposite hormonal effect/environment. For example, estrogen given to a patient with testicular cancer changes the favorable hormonal environment provided by endogenous androgens (male hormones) and causes the tumor cells to die.

Hormonal drugs used to treat breast, ovarian, or endometrial cancer include androgens/progestin and estrogen-blocking drugs.

Hydantoins

Hydantoins act on the cell membrane of neurons in the cortex of the brain. These drugs affect the flow of sodium in and out of the cell, thereby preventing the neuron from depolarizing and repolarizing (i.e., sending out an impulse) rapidly and repeatedly.

Hypnotics

Drugs used to induce sleep are termed hypnotics after hypnos, the Greek word for sleep. These drugs may be either nonbarbiturates which carry a low risk of addiction or barbiturates (Schedule II or III drugs) which are more addictive are the second choice for treating insomnia.

Insulin

Insulin is secreted by beta cells in the islets of Langerhans in the pancreas. This hormone plays as essential role in sugar metabolism. Local Anesthetic Drugs

Local anesthetics provide brief periods of anesthesia in small, localized areas of the skin and adjacent tissues following administration by subcutaneous injection. Local anesthetics are used in dental procedures and for minor surgical procedures/biopsies.

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Locatives

Laxatives are used for short-term treatment of constipation, with attention also given to adequate water intake, dietary fiber/bulk, and other measures to promote regularity. Over- the- counter laxatives are frequently overused and even abused.

There are several classifications of laxatives. These include magnesium laxatives, irritants, bulk-producing laxatives, stool softeners, mechanical laxatives, and others.

Mast Cell Inhibitors

Mast cell inhibitors act to stabilize the cell membranes of mast cells and prevent the release of histamine. This prevents bronchospasm in patients with bronchial asthma due to allergies. Mast cell inhibitors are not bronchodilators. These drugs are not effective in treating acute attacks and are taken continuously for a prophylactic effect. Note: Cromolyn is given by nebulizer or by a special device called a Spinhaler turbo-inhaler that punctures the capsule and allows the powdered drug within to be inhaled.

Mitotic-inhibiting Chemotherapy Drugs

Mitotic-inhibiting drugs act during a specific point in cell division (mitosis) known as metaphase that occurs just before the chromosomes divide and migrate to each end of the cell. Mitotic-inhibiting drugs stop metaphase and prevent any of the subsequent steps of cell division.

Mydriatic Drugs

This group of drugs us used to dilate the pupil (mydriasis) and paralyze the muscles of accommodation (cycloplegia) of the iris. They do this by blocking the action of acetylcholine which normally tends to constrict the pupil. Mydriatic drugs are used to prepare the eye for internal examination and also to treat inflammatory conditions of the iris and uveal tract.

Narcotic

The term narcotic is derived from the Greek work narke which means numbness. Narcotic drugs relieve pain by binding with opiate receptor sites in the brain to block pain impulses to the brain from ascending neural pathways. Natural opiate-like substances in the body (such as endorphins) normally occupy these receptors and produce a natural type of pain relief. There are several different types of opiate receptors; this accounts for the stronger addicting quality of some narcotic drugs compared with others and their different classifications as schedule drugs. The existence of different opiate receptors also accounts for the different kinds of side effects seen with various narcotic drugs.

Common side effects of narcotics include constipation, respiratory depression, sedation, and euphoria. It is the presence of significant euphoria that causes some narcotic drugs to be more psychologically addicting than others. One common narcotic side effect, suppression of the cough center (antitussive effect), is used as a therapeutic effect by including certain narcotic drugs in cough syrups (example: Hycodan).

Narcotic drugs may be directly derived from opium or may be synthetically manufactured.

Narcotic drugs are used to treat moderate to severe pain; provide preoperative and postoperative pain relief, sedation, and a feeling of well-being (euphoria); and maintain general anesthesia. Narcotic drugs are given by mouth or by injection. Nerve Block Anesthetic Drugs

Several anesthetic agents are given via subcutaneous injection directly near a particular nerve plexus (group of nerves) and its branches. This directly blocks all impulses and is known as regional anesthesia or nerve block anesthesia. For example, the brachial plexus can be injected to provide anesthesia of the upper extremity for surgery in that region

Nitrates

As a group, nitrates act as vasodilators throughout the vascular system. By dilating veins, they reduce preload and decrease the need of the myocardium for oxygen. By dilating arteries, they decrease systemic vascular resistance and arterial blood pressure. They also increase the flow of oxygenated blood though the coronary arteries.

The most frequently prescribed nitrate is nitroglycerin. All of the nitrates, including nitroglycerin, can be administered in several different ways. However not every nitrate can be administered by every route.

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Potassium Supplements

Potassium supplements are frequently prescribed for patients taking thiazide and loop diuretics to avoid potassium depletion. Although some foods, such as bananas, are rich in potassium, dietary sources alone are usually not sufficient to replenish potassium loss caused by diuretics. Potassium supplements are manufactured as liquids (patients often object to the taste), powders and effervescent tablets to be mixed with water, capsules, and tablets. Dosages are measures in milliequivalents (mEq).

Prophylactic agent

From a Greek word meaning to keep guard before, a prophylactic agent is administered before the onset of disease or other condition to prevent its occurrence (examples: birth control pills, flu shots, and vaccines: penicillin G is given prophylactically to patients with a history of rheumatic heart disease prior to undergoing surgery or a tooth extraction.

Penicillins

The penicillins comprise a group of antibiotics that can kill bacteria. This group of drugs includes both natural and semi synthetic drugs that share the common molecular structure of a beta-lactam ring. All penicillins act by interfering with the structure of the cell well that surrounds bacteria, causing disruption of the intercellular contents and cell death. Human cells have a cell membrane but no cell wall and so are no adversely affected by penicillins.

Placebo

The term placebo means I will please in Latin. A placebo, of itself, exerts no pharmacologic action. It exerts no therapeutic effect, and produces no side effects. Placebos are used in double-blind research studies in which neither the researcher nor the patient knows whether the medication given to the patient was the drug being tested or was a placebo. Placebos are commonly sugar pills or injections of sterile normal saline solution. Interestingly, while it is physiologically impossible for a placebo to exert pharmacologic effect, patients often report a decrease in certain types of symptoms and can even experience "side effects" when given a placebo. These effects are quite real and demonstrate that, in some situations, the power of suggestion can produce changes within the body that closely mimic the pharmacologic action an actual drug.

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Spinal and Epidural Anesthetic Drugs

Spinal anesthesia involves the injection of an anesthetic agent into the subarachnoid space between the vertebrae of the lumbar region.

Epidural anesthesia involves the injection of an anesthetic agent into the epidural space; the drug then moves into the subarachnoid space to produce anesthesia.

Succinimides

Succinimides act to depress the cortex and raise the seizure threshold.

Sulfonamides

These anti-infective drugs are not classified as antibiotics, but they do inhibit the growth of bacteria in the following way. Some bacteria must manufacture folic acid because it is essential to their metabolism. Sulfonamides interfere with this process and cause these bacteria to die. Certain bacteria (as well as human cells) that can utilize folic acid from outside the cell are not affected by sulfonamide drugs. Sulfonamides are effective against many gram-negative and gram-positive bacteria. Sulfonamides are commonly used to treat urinary tract infections and/or obits media. Sulfasalazine (Azulfidine) is indicated only for the treatment of ulcerative colitis. Sulfonamides are often called sulfa drugs.

Tetracyclines

This group of antibiotics inhibits bacteria. Tetracyclines do so by inhibiting the protein synthesis in the cell wall of bacteria. Tetracyclines are effective against both gram-positive and gram-negative bacteria.

Tetracyclines can cause permanent discoloration of the teeth; therefore, they are not prescribed for pregnant women (to protect the fetus's developing teeth) or for children under age 8.

Thrombolytic Drugs

Anticoagulant drugs are not effective in dissolving clots that have already formed. Instead, tissues plasminogen activators and thrombolytic enzymes are used to lyse the thrombi that obstruct cerebral, coronary, or pulmonary arteries. Both tissue plasminogen activators and thrombolytic enzymes bind to fibrin, the elastic strands that hold a clot together. These drugs then convert the plasminogen in the clot to plasmin. Plasmin (also known as fibrinolysin) is an enzyme that breaks apart (or lyses) fibrin. As fibrin strands are broken apart, the clot dissolves.

A drug that relaxes the smooth muscle of blood vessels to improve blood flow.

Vasodilator drugs block the movement of calcium into the smooth muscle around the blood vessels. The less calcium in the smooth muscle cell, the less strongly it contracts. By relaxing smooth muscle, the blood vessel dilates and the blood pressure decreases.

Although calcium channel blockers act in a similar way to vasodilators, they remain two separate classifications of antihypertensives that are not structurally related to each other.

Vasopressor

A drug that constricts the smooth muscle of blood vessels to increased blood pressure.

This class of drugs is used to increase blood pressure, and treatment with these drugs is begun after the patient has been resuscitated. They are given by I.V. drip. All of these drugs stimulate Beta1 receptors to increase the heart rate; they also stimulate alpha receptors in the blood vessels to produce vasoconstriction and raise the blood pressure.

Vasopressors also have the desirable effect of maintaining blood flow to the kidneys so that kidney ischemia from hypotension does not later result in renal failure, which would complicate an otherwise successful resuscitative effort.